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Home My WebLink About11-04-13 Reset PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY,PENNSYLVANIA Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in support thereof aver(s)the following and respectfully request(s)the grant of Letters in the appropriate form: Decedent's Information � I j / Name: DAVID FREDERICK WERTZ File No: �"► � t ��' ��t (� � a/k/a: D.�P��6�R�CK �q/�ELTZ, (Assigned by Register) a/k/a: a/k/a: Social Security No: 193-30-0357 Date of Death: OCTOBER 16,2013 Age at death: 97 Decedent was domiciled at death in CUMBERLAND County, pENNSYLVANIA (Srare)with his/her last principal residence at 1 LONGSDORF WAY.CARLISLE,PA 17013 SOUTH MIDDLETON TWP. CUMBERLAND Street address,Post O[fice and Zip Code City,Township or Borough County Decedent died at 1 LONGSDORF WAY CARLISLE PA 17015 S.MIDDLETON TWP. CUMBERLAND CY PA Street address,Post Office and Zip Code City,Township or Borough County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania................ ............ All personal property $ ��Q�`j. °= If not domici[ed in Pennsylvania. ........... ............ Personal property in Pennsylvania $ If not domiciled in Pennsylvania. ....................... Personal property in County $ Value of real estate in Pennsylvania..................................................... .... $ TOTAL ESTIMATED VALUE. ... $ Real estate in Pennsylvania situated at: (Attach additional sheets,if necessary.) Street address,Post Office and Zip Code City,Township or Borough County � A. Petition for Probate and Grant of Letters Testamentary Petirioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated �QC,. 3.� �DI� and Codicil(s) thereto dated �;. State relevant circumstances(e.g.renunciation,death of executor,e� � � !a ,� C M G� Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,w�o"�@ivorced,Q�not�a o a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. §C332��d d�ot h��ild born or adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person� A� rn � � �y� �NO EXCEPTIONS �EXCEPTIONS �'' C1> %� C7 �-.j � _'U —r� --.~� � B. Petition for Grant of Letters of Administration (If applicableJ � c� -E-. � _'''� c.t.a.,d.b.n.,d.b.n.c.t.a.,pendent�te rante a�tia,�71ur�e minoritate If Administration,c.t.a. or d.b.n.c.t.a.,enter date of Will in Section A above ant'�mplete li�of la�ear�a �c: Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person. �NO EXCEPTIONS �EXCEPTIONS Petitioner(s),after a proper search has/have ascertained that Decedent leR no Will and was survived by the following spouse(if any)and heirs(attach additiona!sheets,if necessary): Name Relationshi Address Fo,m Rw o2 .�.�oiiriaoi� Page 1 of 2 Oath of Personal Representative Officia]Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND } Petirioner(s)Printed Name Petitioner(s)Printed Address JOANNE MONOSKI 145 PARKER STREET CARLISLE PA 17013 The Petitioner(s)above-named swear(s)or affirm(s)the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s)and that,as Personal Representative(s)of the Decedent,the Petitioner(s)will well and truly administer the estate according to law. Sworn to r affirmed and subscribed before `1 A�� . � .[ Date � �? me t 's � da y o ' l� , � �� Date By: � �_ t.f' Q I`�' Date `==' -- For the Registex �_Date w � � O � 't7 � � CJ: � � � BOND Require : S Q NO To the Register of WiUs: � ys t'- �-:� t�t FEES' Please enter my appearance by my sig�t�'e�glow:-� %'L� � Letters•. . . . . . . . . . . . . . . . . . . . . . $ �JV•�v Attorney Signature: Q � c"'J � � � C� � `r7 � ° ( � )Short Certificate(s). . . . . . ��'. (`�� p c:.: -- � ( )Renunciation(s).. . . . . . . . ' � � �-- � . ' �—�''o � cn � ( )Codicil(s). . . . . . . . . . . . . ,,,,� -� -rf. ( )Affidavit(s).. . . . . . . . . . . y "� Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: THOMAS E.FLOWER Commission. . . . . . . . . . . . . . . . . . Supreme Court Other . . . . . . . . ID Number: 83993 !�,'� . . . . . . . S��?�` " . . . . . . . . � `�.C`ii�� Firm Name: FLOWER LAW,LLC `�,{,1�;�, . . . . . . . . �S-LP?�� Address: 10 W HIGH STRFFT „�� . . . . . . . . ('AR( iSI,�,.PA 17013 . . . . . . . Phone: (717)243-5513 Automation Fee. . . . . . . . . . . . . . . Fax: 5717)241-4021 JCS Fee. . . . . . . . . . . . . . . . . . . . . Email: T(�MnFI nWF.R-I.AW.C'(�M TOTAL. . . . . . . . . . . . . . . . . . . . . $�SZi DECREE OF THE REGISTER Estate of DAVID FREDERICK WERTZ File No: ,1�� -��— ��Cj a/k/a: AND NOW, �� ,�(,��,� , � �� , in consideration ofthe fo egoing Petition, satisfactory proof having been presented before me,IT IS DECREED that Letters � �fi � ` are hereby granted to �,� i �. '� �' �' in the above estate and(if applicable)that the instrument(s)dated l��t" �/' ��, 7.(r�(1 described in the Petition be admitted to probate and fil d of record as the last Will (and Cadicil�s)) of Decedent. �� %'1 � ✓ � ?� ; �/ � �� Register of Wil�s '� �� j�,��,�r�i� f �,. U l. " Y Form RW-02 rev. ioii�izoii Page 2 of 2 HI05.805 REV(9/11) " LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 �,,,,��""'��---. This is to certify that the information here given is �� £ �F �,,�,'��,P`�H OF pF�;y= conectly copied from an original Certificate of Death ��G��1�� Q� ��d)( �� ;a`°o`t` =- `��; duly filed with me as Local Registrar. The original � ;� �� y� certificate will be forwarded to the State Vital ;�ji3 �!�� y P� 2 yS i�- ,. a� Records Office for permanent filing. ',t ,t,� , a4 � � � � � � � � CLERK 0� o��q9T ' E�.�a~� CZ�an�A.'��-�e�' OC�( 18�2013 ---,MENT 0 �g Q��f Q�c� �� "'°""""'��'11 Local Registrar Date Issued Certification Number . Type/Princ In ��I5/1 t(�R�A F�t��01p/JWE�T}I OF PENNSVLVANIA�DEPARTMENT OF HEA�TH�VITAL RECOR�S . Permanent � '��"' �< <'1�Y tJV � ii CERTIFICATE OF DEATH B�ack Ink State File Number: 1.�ecede�t's legal Name(First,Middle,Last,Suffix) 2.Se 3.Soclal Securi[y Number 4.DaCe of Ocath(MO/Day/Y� Speil Mo) David Fredericic Wertz ��e 193-30-0357 October 16, '�L�013 Sa.Age-last Birthtlay(Vrs) Sb.Under 1 Vear Sc.Under 1 Oa 6.Dafe of Birth(MO/Oay/Vear)(Spell Month) 'la.Birthplace(City and Sfate or Forcign Coun[ry) a� 97 Monchs oays Ho��s nni.,�tes pet 5, 1916 ' 7b.Birthplace(COUniy) Sa.Residence(Stete or Fo�eign Country) Sb.Residence(Street and Number-Include Apt No.) Sc.Ditl Oec¢dent I.IVe in a Township7 � PA 1 L.ongsdorf way �Yes,decedent Iived in co+ t► 1�1' d1 on t,,,,P. sa.aestae.,�e�co�.,cy� CL]ITIIJ2L'Z$I1C3 � 8e.Residence(Zip Code) 17Q1 �No,decedent lived wtthin ilmits of cRy/boro. 9.Ever In U Armed Forces7 10.Marital Sfatus at Time of Death �Married �] Widowed IS.Surviving Spouse's Name(If wife,give name prlor to first marriage) �Ves �No 0 Unknown �Divorced O Never Marrled �Unknow 12.Father's Name(First,Middle,Last,Sufflx) 13.Mother's Name Prlor to Firs[Marriage(First,Middle,Last) - Jesse Price� Wertz Ada Barratt 14a.Informant's Name 14b Relationship to Decetlenf 4c 1 formant' Mailing Address(5 t d N ber, St deJ Joanne W_ Monos3ci daugl-rter �1�� Par�cer St_ , G�'ar�is�e, �A :�� 0 G .......................................................... ............°-----'---........._..--'°.....-----isa.v.ace o__oeaz...c ec__o�.yo.,e "'.........""""...... .................."".........."'-'s�a••"-""""........................ _ If Death Occu��ed in a Hospital: Inpatient ' ;If Death Occ�r�ed Somewhere Other Tha�a Hospltal: �Hospice Facili(y . u Decedent's Home ° �EmergencyROOm/OUtpatie�t Q Dead on Arrtval �]Nursing Home/Long-Term Care Facilify Other(Specify) � �d i5b.Facllity Name(If not institution,ylve straet and number' •15c.City or y.�n, fate,a G Zip . 15d.Co Sy f pcat Cumberland Cro�sings Ftetr_ Comm. Car�is�e, PA ��15 �i.am�erq.an �, 16a.Method of Disposition � B�rial Cremation 16b.Da[e of Disposiiion 16c.Place of Olspositlon(Name of ceme�ery atory,o�other place) p ReR,ova�+.a.,,s�ate p oo„a��o., Oc 201 Hof£man-Roth FuneraY�eHOma & Crematory - Other(Specify) � .16d.Location of DlspOSitlon(City or Town,Staie,and Zip) 17a.5( ature Funeral Service Lice r Person In Charge of Inferment 17b.!i Numbe� Carlisle, PA 17013 0��44L � E 17c.Name and ComRlete Address of Funeral Facility � 3 HoPfman-ROth Funeral Home & Cremato 219 NortYi Hanover Street, Carlisle, PA 17013 m 18.Decedent's Education-Check the box tFiat best descri6es the 19.Decedent of Hispanic Origin-Check the 20.�ecedent's Race-Check ONE OR MORE races to Indicate what �-- highest degree or level of scFOol completed ac the cime of death. box thaf best describes whether the decedent the deceden[considered himself or he�self to be. � 8th grade or Iess Is Spanish/Hispanic/LaNno. Che<k the"NO" �]White 0 Korean Q No diploma,9th-12th grade box iF decedent Is not Spanish/Hispanic/LaLino. �Black or African American Q Vle�namese 0 Htgh school gratluate or GED completed �No,not Spanish/Hispanic/Latino �American Indian or Alaska NaYive Q Other Aslan � Some college credii,but no degree �Ves,'Mezican,Mexican American,Chicano �Aslan Indian � Native Hawailan � Associate degree(e.g.AA,AS) 0 Yes,Puerto Rican �Chinase 0 Guamanian or Chamorro � Bachebr's degree(e.g.BA,AB,BS) �Ves,Cuban O F��a��o p samoa� 0 Master's degree(e.g.MA,M5,MEng,MEd,MSW,MBA) Q Ves,other Spanish/Hispanic/LaTino �Japanese O �iher Paciflc Islander � Doc�orate(e.g.PhD,EdD)or Professional degree (Specify) �Othe�(Speclfy) .MD,pDS,DVM LLB,JD 21.Decedcnt•s Single Race Self-Designation-Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a.Oecedent's Vsual Occupation-Indlcace type of work �`�/hi[e �Japanese �Samoan done during most of working Ilfe. DO NOT USE RETIRED. (�Biack or Afrlcan American Q Korean Q Other Pacific Islander �American Indian or Alaska Native �Vietnamese 0 Don'(Know/NOt Sure Bishop 0 Asian Indian �Other Aslan Refused �Chinese 0 Native Hawalian Q Other(Specl ZZb.Kind of Business/Industry � O Fllipino p�„ar„ar,�a.,or cnar.,orro �� Ministry ITEMS 23a-23d MUS COMPLETEd 23a.Date Pronounced Deatl(MO Day Yr) 23b. gnature of Person P�ono Ing Death(Only when applicable 23c.UcenSC Numbe� BY PERSON WHO�PRONOUNGES OR �� / _ •1/1 ^'� CERTIFIES DEATH � �<<� � Q�i,if�L.,,-�.Q��-•�`-- ��JS�G I �� 23d.OBfe��n�d��/Day/Vr) �� 24,Tim of Deaih� �(« ! 25.Was Medicai Examiner or Coroner Contactetl? 0 Ves No � � � � CAUSE OF DEATH Approximate 26.PaK 1. Enter the chain of events--diseases,injurles,or mplicatlons--that dlrectly c sed the death. DO NOT enler terminal e ents such a ardiac arrest Interval: respiratory arrest,or ventricular fibrlllation without showing the eriology. DO NOT ABBREVIATE. Enier only on cause on a line. Add addlHOnal lines If necessary� Onset to Death �/ e � IMMEDIATE CAUSE ------- a. GftiF9 S�- 7`` � � "�.` G-��-c� • ' ____"'__> : (Final disaase or contlition �pue to(or as a canseq�ence of): res�lting in death) b. Sequentlally Ilst cOnditbns, Due Co(or as a consequence of): if any,leatli�g to the cause Ilsietl on Iine a. Enter the UNDERLVING GAUSE O�e to(or as a consequence oT): (disease or injury that � initiatetl the evencs res�iting d. � in death)LAST. Due to(or as a consequence of): � � Z6.Part 11. Enter otM1er sl¢nifcant condixi t ib tl t d th but not resulting in the untlerlytng cause given in Par[I 27.Was an auTOpsy perFOrmedT O � . � � Yes � No � 28.Werc a�topsy flntlings avallable � to complet�the cause of daach7 °� O ves No ^+ 29.If Female: 30.Did Tobacco Vse Contribute to DeathT 31.Manner of Death a � No[pregnant wifhin pas�year � Yes Q Probably ural Homicide � Pregnant at time of death � � Unknown Q Accltlent � Pending Investlgatton � � Q Not pregna�t,but pregnant wifhin 42 days of death - � Not pregnant,but pregnant 43 days to 1 year before deatFi 32.Date of In'ury(MO/Da Q Suicide � Co�ld not ba determined 0 V nknown if pregnan�wlthln the past yea� � Y/�'r)(Spell Month) 33.Time of I�jury L� 34.Place of Injury(e.g.home;construction site;farm;school) 35.Location of InJury(SGreet antl N�mber,Cliy,State,Zlp CoAe) ✓ _ 36.Injury at Work 37.If Transportatlon InJury,Specify: 38.Describe How InJury Occur�ed: � Ves �Driver/Operato� O Pedestrtan Q No �Passenger 0 Other(Specify) ,-r'1 39a.Certlfter(Check only one): ' ertifying physician-To the best of my knowledge,death ocwrred dua to the cause(s)and m r stafed 0 Pronouncing Sa Gertifyfng physlcian-To the best of my knowledge,death occ�rred at the time,date,and place,and due io the cause(s)and manner sta[ed • � �Medical Examiner/COroner-On the asis of examination,and/or Investigation,In my opinion,death red at the fime,date,and place,and due to the cause(s)a�nyd manner stated Signaiure of certifie�: Titl¢of ceKifler: �r' [7 License Number ddCO / �S - L 39b.Nam.e,AddreSS and Zip Code of P Completing Cause of Death(I[em 6) � 39c.Date S�gnctl Mo/�ay/Vr) � 40.Reg{st�ar is[rict NUm er 41.Registrar's ignacure (6�C �C�� 42.Registrar Flie�ate(MO Day Y�) � t- �_'��'�.`�c- e�r ��. i6�, �t3 � 43.Amendments � � � � � DispositlonPermitNO. V�T,�O� H105-143 � REV 07/20]1 z,�sr wIL��vD rESr�rE�Q �� > � �� .. . �� rni":d �„� L-= U'3 �,�3 �^ ....� � �,. I"' r...�A t„y i OF � .� �� ,x , ; r:.� c.� �. r�:y �M � ;-: r�.) f.-� ��_z � —r t `""s ,;°� S.'�_f .._�.� D. FREDERICK WER7''z _-> ��, r„ �. ,��;�; � �..i _�' {'r �7 �Il I, D. FREDERICK WERTZ, of Cumberland Crossings Retirement Center, 1 Longsdorf Wa��, I�To. 43, Carlisle, Cumberland County, Pennsylvania, being of sound . . . . ai�ii '��YO�iii� iI'liii�, iilEiTiiviy �iiiCi tiiluciS�dliiiiii�, c�U illdlif'., iJU:ilis�i and ueciare t'rus as and for my Last Will and Testament, hereby revoking and making void any and all former Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and ciirect my Executrix or Executor, hereinafter named, to pay all my just debts, funeral expenses, testamentary� expenses and all Inheritance, F.state, Transfer and Succession Taxes, as soon as may be conveniently done after my death, out of my residuarv estate. SECOND: I give my entire estate of whatsoever nature and kind as follows: ��. I give to ALLISON tiNITED METHODIST CHURCH of Carlisle, Pennsylvania, three (3%) percent of the residue; B. I give to LYCOMING COLLEGE of Williamsport, Pennsylvania, three (3°,%) percent of the residue; C. I give to DICKINSON COLLEGE of Carlisle, Pennsylvania, two (2%) of the residue; D. I give tc� UNITED METHODIST FOUNDATION OF WEST VIRGINTA, INC., 1'.O. Box 3811, Charleston, West � �'irginia 253.38-3811, tw� ;2%) Percent of the residue; . E. I give the remainin� ninet}� (90°,%) Percent to my children ROBERT GARY WERTZ,JOANNE WERTZ MONOSKI, DONNA WERTZ REAM, and ELIZABETH WERTZ MAISONPIERRE, in equal shares, to share and share alike, per stirpes, without regard to any advancements I may have made to any of my children during my= lifetime. LASTLY: I nominate, constitute and appoint my daughter,JUANNE WERTZ MONOSKI, to be the Executor of this my� Last Will and Testament. In the event that the said Executrix shall be unable to serve as Executrix for any reasot�, I appoint my� daughter, ELIZABETH WERTZ MAISONPIERRE, as Executrix. No Executor or Executrix shall be required to file bond in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this � � � day of--�,G'�'�� ,-1�t , 2011. � � � �i� D. Frederick Wertz SIGNED, SEI�LED, PUBLISHED and DECLI�RED in the presence o£ '��"'J�f,f„!�� 'I�.�� 4--� �� i� )f +V J'' . /7 / COMMONWEAI,TH OF PENNSYLV��NI� . : SS COUNTY OF CU�IBERLr�ND . 17 ,� On this, the a��day of December, 2011, before me �tblK+�S �.��-- , notar� �ublic, the undersigned officer, personally appeared James D. Flower, Jr., of Flower Law, LLC, known to me (or satisfactorily proven) to be a member of the bar of the highest Court of said sr.ate, Supr�me Court ID Number 27742, and a subscribing witness to the within instrument, and certitied that he was personally present when D. Frederick `�'ertz, the Testator, signed the attached or foregoing instrument, having been duly qualified according to law, and having acknowledged to said attorney that he signed and executed the instrument as his last Will, that he signed it willingly, and that he signed it a� his free will and voluntary act for the purposes therein expressed. In witness whereof, I hereunto set m`� hand and official seal. � �-^ D. Frederick Wertz, Testator Notary Public �oMr��;vw�,��rH t��w�w�e�n.v�r�ia NOTARIAL SEAL THOMAS E.FLOWER,Notary Public Carlisle Boro.,Cumberland County My Commission Expires October 26,2014 COMMONWE�LTH OF PFNNSYLVI�NI1� . : SS COUNTY OF CUI�TBERLAND . sl On this, the �� day of Decem'uer, 2011, before me ��IMo��Gl=��— ; nota ,� public, the undersigned officer, personally appeared James D. Flower, Jr., of Flower Law, LLC, known to me (or satisfactorily proven) to be a member of the bar of the highest Court of said state, Supreme Court ID Number 27742, and a subscribing witness to the within instrument, and certified that he was personally present when he and +�ie.W.J L, � L�'ul�e�� , whose names are signed to the attached ;nstrument, being dulv qualified accoYdin� to la��, did depose and sa�� that they were present and saw 1 estator sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each witness in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of their knowledge the Testator was at that time 18 or more y ears of age, of sound mind and under no constraint or undue influence. In witness whereof, I hereunto set my hand and official seal. rr� �. Witness t...� ��'it��s� Notary Public COMMqNW�Al,1'M C?P�'PEIVNSYLVANIA NOTARIAL SEAL THOMAS E.F�OWER,Notary Pubiic Carlisle Boro.,Cumberland County My Commission Expires October 26,2014